Dudak Damak Yarıklı Yenidoğanlarda Preoperatif Ortodontik Yaklaşımlar
Özet
Dudak damak yarıkları (DDY), kraniyofasiyal bölgede en sık rastlanan konjenital anomali olup genetik lokusların yanı sıra maternal sigara, alkol kullanımı ve enfeksiyonlar gibi çevresel faktörlerden etkilenmektedir. Bu anomaliden etkilenen bireylerde maksiller gerilik, posterior çapraz kapanış gibi iskeletsel anomaliler ile konjenital lateral diş eksikliği, süpernümerer dişler ve gömülü kaninler gibi dentoalveolar problemlere sıklıkla rastlanmaktadır. Fiziksel görünüm ve konuşma güçlükleri ise çocuklarda depresif bozukluklar ve sosyal anksiyete riskini artırmaktadır. Bebeklik döneminde beslenme ve estetik deformiteleri minimuma indirmek amacıyla uygulanan preoperatif nazoalveolar şekillendirme (NAM) tekniği, cerrahi öncesi alveol segmentlerini hizalayarak dudakları yaklaştırmakta ve özel nazal stentler sayesinde burun kıkırdağını şekillendirmektedir. Doğumu takip eden ilk günlerde baş aşağı pozisyonda alınan ölçülerle hazırlanan bu apareyler, operasyon sonrası skar dokusunu azaltarak sekonder cerrahi ihtiyacını ve dolayısıyla tedavi maliyetlerini düşürmektedir. Tedavi süreci ebeveyn katılımı ve motivasyonu gerektirse de, bebekteki estetik ve fonksiyonel iyileşme ailelerin anksiyete düzeylerini de azaltmaktadır. Sonuç olarak DDY yönetimi; doğumdan itibaren ortodontist, cerrah ve diğer uzmanların iş birliğini şart koşan son derece kapsamlı, multidisipliner ve uzun soluklu bir süreci kapsamaktadır.
Cleft lip and palate (CLP) is the most frequently encountered congenital craniofacial anomaly, influenced by genetic loci as well as environmental factors such as maternal smoking, alcohol consumption, and infections. Individuals affected by this anomaly often present with skeletal deviations like maxillary deficiency and posterior crossbite, alongside dentoalveolar problems including congenital missing lateral teeth, supernumerary teeth, and impacted canines. Furthermore, physical appearance and speech difficulties increase the risk of depressive disorders and social anxiety in children. Presurgical nasoalveolar molding (NAM), applied during infancy to minimize feeding and aesthetic deformities, aligns alveolar segments to approximate the lips and shapes the nasal cartilage via specialized nasal stents before primary surgery. Fabricated using impressions taken in an inverted position within the first days following birth, these appliances reduce postoperative scar tissue, thereby decreasing the need for secondary surgeries and lowering overall treatment costs. Although the treatment protocol demands active parental compliance and motivation, the observable aesthetic and functional improvements in the infant significantly reduce parental anxiety levels. Consequently, CLP management encompasses a highly comprehensive, multidisciplinary, and long-term process starting immediately at birth, requiring close collaboration among orthodontists, surgeons, and other medical specialists.
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